Telemedicine gains ground in treatment of injured workers

Telemedicine is gaining ground in treating injured workers, especially in rural areas, to speed their evaluation and possibly reduce the costs paid by employers.

Telemedicine, which is defined in workers compensation as a remote, virtual interaction involving two or more parties in the claims process, has long involved telephone communications be-tween workers and pharmacy benefit managers, or treating physicians and specialists, experts said. It's evolved in recent years to include remote face-to-face interactions and the remote measuring of vital signs.

The costs associated with treating workers in rural areas, in addition to more awareness about telemedicine and increased acceptance of technology, has led the industry to embrace the 40-year-old practice in new ways, said Jonathan Linkous, CEO of the American Telemedicine Association in Washington.

For example, a February Rand Corp. study that examined a telemedicine program and a July 2013 study by researchers at University of California Davis Children's Hospital found telemedicine improves the quality of healthcare for children in rural areas.

In Nevada, a large number of workers in rural areas who lack easy access to medical providers and a request by the Nevada Hospital Association prompted the state Department of Business and Industry's Division of Industrial Relations to propose a rule that would require insurers and third-party administrators “to pay for telemedicine services under certain circumstances” and add it to the state's medical fee schedule

While it was shelved last month, it may turn up as part of an overall revamp of Nevada's workers comp law next year.

“In the state of Nevada, we have two primary urban population centers,” said Katherine Godwin, medical unit supervisor of the workers compensation section at the Nevada Division of Industrial Relations in Henderson. “Apart from that, the state is basically rural, so convenient access to medical care can be a challenge.”

A large rural workforce also is driving Oklahoma to consider making more use of telemedicine in workers comp, said Robert Gilliland, a commissioner on the Oklahoma Workers' Compensation Commission.

Costs can add up quickly when injured workers travel long distances to seek medical care for injuries, he said.

For example, Nevada rules allow injured employees to be reimbursed for “out-of-pocket expenses for meals, lodging and actual mileage related to an authorized medical examination, reasonable and necessary medical treatment, vocational rehabilitation or vocational retraining which requires travel in excess of 20 miles round-trip to and from the injured employee's home to the location of such services.”

Aside from workers comp, more employers in general are embracing telemedicine as the care and cost benefits associated with it become more evident, said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president of medical quality and corporate medical director at Sedgwick Claims Management Services Inc.

The benefits include keeping injured workers out of emergency rooms, reducing or eliminating wait times for workers who need to see specialists, and improving their return-to-work rates, she said.

“A patient visiting his occupational healthcare provider who needs an evaluation from an orthopedist could have the consultation right on the spot, via a conference call during which results of diagnostic tests are projected onto a screen visible to the specialist,” Kimberly George, senior vice president and senior healthcare adviser at Sedgwick, wrote on the firm's blog.

“Consider restaurants, for example, where burns are a fairly frequent occurrence,” Ms. George, wrote. “Using telehealth, a nurse at a remote location can evaluate the symptoms and determine whether the worker needs to be seen directly or can be discharged with instructions for home care. The technology is sophisticated enough to allow the provider to see deep into the hair follicles — much more advanced than, say, Skype or FaceTime,” and it complies with the Health Insurance Portability and Accountability Act, she wrote.

In many cases, telemedicine exams take place at a worksite or a central location where “pieces of equipment that look something like an iPad” are set up in booths for privacy, Dr. Bartlett said. “You push a button, and there's a doctor that appears on the screen and they can see you.”

Exams such as blood sugar levels, EKGs, pulmonary function and hearing tests can be performed and the information relayed to physicians in real time, she said.

Many physicians are also fans, Dr. Bartlett said.

“Physicians have told me they feel it's a higher quality healthcare experience because they're really focused on all aspects of the patient” even though the physician payment remains the same, Dr. Bartlett said.

“It's just providing a convenience to a patient,” she said.

Some medical providers could be hesitant to embrace telemedicine not only because it's different, but also because it has the ability to stimulate competition, Linkous said.

“From the patient side, it's great because you can choose among a variety of different physicians, but from the physician side, they're a little afraid they might lose a patient or two,” he said.

And more provider options could mean better prices for employers and insurers, experts said.

This is one reason TPAs such as Sedgwick work with clients to implement the technology through companies, including Concentra Inc. or Kaiser Permanente, that make telemedicine accessible on worksites or at a number of central locations, Dr. Bartlett said.

“It's still relatively new to the employers out there,” she said, “even though there's a lot of buzz about it and it's being used widely in healthcare. It's still something that's being carefully examined in the workers comp space.”

Linkous said it helps to think of telemedicine as a tool rather than a specialty.

“We're not talking about telemedicine, we're talking about medicine,” Linkous said. “It's just another tool you can use in providing healthcare services. ... It may take a little training to use it, but it takes training to listen to a heart sound on a stethoscope, too.”